Breast Reconstruction After Mastectomy

After a mastectomy, the last thing you want is yet another major surgery. With our BRAVA + AFT (autologous fat transfer) procedure you will not be cut open again. As compared to the traditional methods, this involves no incisions, no new scars, no foreign objects and it recreates a natural feeling breast with the benefit of liposuction.

Plus, you will keep as close to normal sensation in your breasts and nipples. The procedure is covered by insurance for breast cancer patients.

At the Miami Breast Center we understand that the breast cancer journey is filled with many emotions. This is why we want to ease your mind about your breast reconstruction decision.

Whether you’ve had a “simple” or “total” mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, or a subcutaneous (nipple-sparing) mastectomy, or are considering a prophylactic mastectomy, you are probably a good candidate for our breakthrough, minimally invasive breast reconstruction technique.

Our Mastectomy Reconstruction (Regeneration) Procedure

1st Stage: BRAVA Expansion & Fat Grafting

Left: Tight mastectomy defect with transverse scar.

Center: Under the effect of BRAVA expansion the scar is pulled out, the skin envelope enlarges, and the tight tissues fill up with body fluids to turn into a looser fibrous scaffold with more blood vessels. This process of BRAVA-induced neoangiogenesis requires at least 10 days of expansion.

Right: Fat graft droplets are injected into the scaffold seeding it diffusely and evenly. The fat grafts passively fill up the expanded space. We cannot expect the fat graft to inflate the mastectomy defect beyond what was achieved with BRAVA expansion. This stage will result in a breast mound that is always slightly smaller than the maximal BRAVA expansion effect.

2nd Stage: Additional BRAVA Expansion & Fat Grafting

Left: After the first fat graft stage, we have a small breast mound often with residual scar from the original mastectomy still denting or tethering the skin.

Center: Additional BRAVA expansion pulls on the tissue to further stretch the scar, expand the skin envelope, and generate more space and a larger fibro-vascular recipient scaffold. At this stage the patient often requires a larger, deeper BRAVA dome to accommodate the larger breast.

Right: More fat graft droplets are meticulously seeded into the scaffold and survive to yield a nice breast mound.

Mastectomy Reconstruction Step-by-Step Case

Ideal Candidate Before Reconstruction

This woman is an ideal candidate for BRAVA + AFT breast regeneration. Her breasts are not radiated. She has loose mastectomy scars and ample fat. Since she also has bilateral defects, both breasts will regenerate symmetrically and we do not have to match a normal side. She is successful because she understands and is compliant with how BRAVA should be worn.

Expansion After Using BRAVA for Four Weeks, Before 1st Fat Grafting Procedure

After using BRAVA for 4 weeks, she has nicely expanded the mastectomy defects and presents for the first grafting session with “edema” breasts. This swelling is temporary as there aren’t any fat cells to fill up the stretched, loose tissues. If she stops BRAVA at this point and doesn’t have any fat grafts, the swelling will completely subside. Notice that while the left breast filled up into a nicely shaped mound, the right side is still dented by a transverse scar that BRAVA was unable to fully release.

Breast Expansion Inside BRAVA Domes from First to Last Procedure

These are lateral views of the left breast inside the BRAVA domes over the course of her treatment.

1, 2, and 3 show progressive expansion of the mastectomy over the first 4 weeks of BRAVA treatment before the first graft.

Notice how the generated mastectomy mound has completely filled up the dome and she had to move to a deeper dome.

Shows the amount of expansion at the time of the first graft.

Depicts the expansion at the time of the second graft.

Shows further expansion at the time of the final and third graft. Notice that she then had to graduate to an even deeper dome.

Before 2nd Fat Grafting Procedure

In this photo the patient is shown with her surgical markings for the liposuction and fat injection just before the second fat grafting session.

Before 3rd and Final Fat Grafting Procedure

This shows the surgical markings for the liposuction and fat injection just before the third fat grafting session. Notice how the dented scar retraction on the right breast progressively improves and will be the focus of treatment in this third and last procedure.

Final Results After Three Fat Grafting Procedures

The patient has regenerated large, symmetrical, D cup breasts after 3 BRAVA + AFT sessions over 6 months. These new breasts feel natural, just like the original ones. They are soft, bouncy, and best of all, the reconstructed nipple has near-normal sensation.

Patient Exam Video

Am I A Candidate for the BRAVA + AFT breast regeneration procedure?

Most women are candidates for our procedure. There are only 4 disqualifiers:

1. Smoking
Smokers have a poor capacity to regenerate tissue. We recommend that a patient stops smoking at least 2 months before the procedure and abstain from even a single whiff or puff throughout the process and for 3 months after. If she cannot comply, we cannot help her.

2. Herceptin® Chemotherapy and Other Angiogenesis Inhibitors
These prevent the revascularization of the fat graft and lead to a poor outcome. We recommend the process be started about 1 month after a patient completes her course of Herceptin treatment.

3. Aspirin and Other Over-the-Counter Food Supplements and Vitamins That May Impair Blood Clotting
We have seen disastrous results when a patient has prolonged bleeding time from long-term use of Omega 3 fatty acids, ginkgo biloba, garlic, ginger, ginseng, vitamin E, herbal tea, and green tea to name a few. It is imperative that the patient stops aspirin, all vitamins, and all herbal supplements at least 2 weeks before the procedure.

4. Poor Understanding of the Procedure and Inability to Comply With the BRAVA Expansion Treatment
Individuals that can not comply with the daily use of BRAVA to assure best procedure results. A large part of a patient’s success is tied to proper usage of the BRAVA for their circumstances.

Mastectomy Surgery

Ideally, the procedure begins in the hospital at the time of your breast cancer surgery. Dr. Khouri will join your oncological surgeon in the operating room. Right then and there, he will begin the reconstruction process by removing and then injecting some of your own fat into the breast area, so that you leave the hospital with a slight breast mound.

Note: For those patients who had a mastectomy in the past, the procedure begins with the next step below.

Using BRAVA

The patient will then wear the external expander device called BRAVA, while sleeping, for 3 to 5 weeks prior to the first grafting session. BRAVA is a comfortable soft gel-like bra. See BRAVA page for more details. Not only does BRAVA expand the skin from the outside, it also has the effect of regenerating an edema like breast mound through the expansion of tissues and nerves. BRAVA also increases the blood flow to the mastectomy scar and improves the radiation effect. This does two important things, which are unique to this technique:

It creates an adequate vascular matrix into which the liposuctioned fat is later injected.

It allows the patient to keep almost normal sensation in her breasts and nipples.

Fat Transfer

These micro-fat grafts are harvested by gentle liposuction from the patient’s thighs, buttocks and stomach – wherever there is fat to spare.

Once the patient has worn the BRAVA for a few weeks, the out-patient fat transfer procedure is performed. Fat is removed from one area of the body and meticulously injected back as hundreds of tiny individual droplets at the breast site that has been enlarged by the BRAVA expansion. These micro-fat grafts are harvested by gentle liposuction from the patient’s thighs, buttocks and stomach – wherever there is fat to spare.

The transferred fat then survives within this matrix of tissue and the breast mounds are restored ‘naturally’ over the ensuing three months while the patient receives the benefit of liposuction. This new breast mound feels and looks like the patients’ very own but contains no breast tissue – only the transferred fat. Best of all, the mound has sensation, and the nipples we reconstruct look and feel normal.

We are currently able to achieve up to a small B cup natural breast filled with your own fat with only one small outpatient fat grafting procedure. To attain larger breast cup sizes, the fat grafting process usually has to be repeated 2-3 times over a period of 2 – 6 months.

Benefits of Dr. Khouri’s Procedure

With Dr. Khouri’s micro-fat grafting procedure, you could be back at work within 1-2 weeks, while a full recovery can be expected in 3 months. No morbidity, no foreign material, no cuts or incisions, no new scars, and the patient keeps near-normal sensation in her breasts. All our patients love the side benefit of body sculpting too.

Issues with Traditional Breast Reconstruction

There are 3 traditional breast reconstruction alternatives. ALL involve major “open” surgery, which means muscle trauma and new scars.

The implant alternative involves the placement of a foreign object such as silicone or saline under the muscle and leads to an artificial feeling breast mound. Implants are not a permanent solution.

The tram flap surgery alternative involves taking a piece of muscle and tissue from the back or the abdomen and using it to rebuild a breast mound. The surgery is extensive, it requires major incisions, a prolonged recovery and the result is like patch work and still often requires an implant.

The DIEP flap procedure also involves a lengthy surgery with the removal of abdominal fat and skin. Though this is some of the best looking results, it is imperative that the procedure be done by a specialist expert who performs lots of these on a routine basis. Otherwise the morbidity, complication and failure rates are very high. And even the best results feel and look like patch work . This procedure also involves a prolonged recovery time.

This innovative procedure is the very first that facilitates reconstruction of an entire breast from fat with no major surgery.

Clinical Trials

Dr. Khouri has done clinical studies to prove the safety and efficacy of his procedure and has presented these studies at all the important medical conferences across the globe including the American Society of Plastic Surgeons Annual Convention. Dr. Khouri has the world’s best documented experience on the subject. Dr. Khouri’s work was just awarded the best scientific achievement at the Annual Meeting of the European Association of Plastic Surgeons (EURAPS) and he will be delivering his presentation and receiving the award at the Annual Meeting of the American Association of Plastic Surgeons. As a tribute to his contributions to microsurgery (this is how DIEP flaps are done) he will be delivering the Presidential Lecture entitled “Beyond Microsurgery”.